Binney, Rockson is always testing ketoprofen, but it doesn't seem like a "cure". And as we've discussed, payment in medicine is for procedures--not thinking, so I'm not surprised at the surgeons finding their way into LE.

As we also discussed, any surgeon can do any surgery, and insurance will start to pay for it, once it's determined not to be experimental. A few years ago, when LVA was still considered experimental, I talked to one of the main surgeons and he said it was not a cure. 

Funny how that's changed.

Several years ago, there was a great study where patients were told they were going to get arthroscopic clean out surgery for arthritis, and all were taken to the OR, all were put to sleep and everyone got a scar, but only half got surgery. And there was NO difference. And yet the surgery is still being done, and still paid for.

And searching pubmed, there's a similar study from last year--in New England Journal

http://www.ncbi.nlm.nih.gov/pubmed/24369076

N Engl J Med. 2013 Dec 26;369(26):2515-24. doi: 10.1056/NEJMoa1305189.

Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.

Sihvonen R¹, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group.

Collaborators (9)

Author information

Abstract

BACKGROUND:

Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.

METHODS:

We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery.
The primary outcomes were changes in the Lysholm and Western Ontario
Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100,
with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure.

RESULTS:

In
the intention-to-treat analysis, there were no significant
between-group differences in the change from baseline to 12 months in
any primary outcome. The mean changes (improvements) in the primary
outcome measures were as follows: Lysholm score, 21.7 points in the
partial-meniscectomy group as compared with 23.3 points in the sham-surgery
group (between-group difference, -1.6 points; 95% confidence interval
[CI], -7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively
(between-group difference, -2.5 points; 95% CI, -9.2 to 4.1); and score
for knee pain
after exercise, 3.1 and 3.3 points, respectively (between-group
difference, -0.1; 95% CI, -0.9 to 0.7). There were no significant
differences between groups in the number of patients who required
subsequent knee surgery (two in the partial-meniscectomy group and five in the sham-surgery group) or serious adverse events (one and zero, respectively).

CONCLUSIONS:

In this trial involving patients without knee
osteoarthritis but with symptoms of a degenerative medial meniscus
tear, the outcomes after arthroscopic partial meniscectomy were no
better than those after a sham surgical procedure. (Funded by the Sigrid Juselius Foundation and others; ClinicalTrials.gov number, NCT00549172.).

Look, we all want a cure for this, and brave people are putting themselves out there as essentially guinea pigs, but a surgical mentality is not to establish long term relationships with patients.

Hopefully as we understand risks and eliminate unneccesary risks in treatment--like less ALND, more careful radiation planning, awareness of the risks of chemo and LE, careful handling of the tissues in surgery, careful post op instructions and if we can identify high risk people early--we can make the burden of LE far less.

Carol, if only it was that simple. When Rockson was still talking to me, he told me that ibuprofen made people swell, but ketoprofen did not. Both are anti-inflammatory agents.

Statins do seem to have both long term benefits and some harms--raise glucose levels, muscular issues, and ?cognitive issues. 

And the long awaited newest lipid guidelines came out to huge controversy--the risk calculator seems flawed....

KS1, that's so interesting that the steroids turned it around. I remember how stubborn it was. It isn't just a plumbing problem.